Medrants writes today:

First, I would outlaw direct to consumer marketing of prescription drugs. DTC puts physicians in a difficult situation. We do feel pressure to prescribe the medication that the patient requests. Some of us have the time and presence to resist that pressure, but many physicians are so harried that writing the prescription rather than arguing is the easy way - saving them 5 precious minutes. (And ...

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With media focus on Bill Clinton's impending bypass surgery, the INTERHEART study that I briefly alluded to recently has received an early-release from the Lancet.

Some observations:
1) Smoking and a poor cholesterol ratio accounts for the majority of risk.
2) Psychosocial factors ("stress") plays a significant role.
3) The cholesterol ratio they used was the ApoB/ApoA1 ratio. What does this mean? From UptoDate:

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Saturday reading

Lots of interesting stories to start your long weekend.

Advice for patients who want to buy medications online and limiting physicians' liability:

Limit your involvement when it comes to Internet pharmaceutical purchases. Serve only as an information resource for your patients. Give them information from the FDA about the risks of getting drugs through the Internet, then let them make informed decisions.

Lessons in residency that don't always apply ...

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Medrants has written on the "Canadian solution" that many are advocating to contain the costs of prescription drugs. As he puts it so eloquently, it's like treating a deep abdominal wound with a band-aid:

We need higher level thinking to better understand pharmaceutical costs and our resultant expenditures. The “wonder drugs” are not created by spontaneous combustion. They result from expensive research.

Physicians need to understand newer ...

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Today the Massachusetts Department of Public Health came down with its decision on South Shore hospital, just south of Boston. I have written about the situation previously and followed up here.

The Department of Public Health report, released yesterday, ends review of a dozen complaints about the pace of care in South Shore's emergency room since last year. It found that emergency room staff at the ...

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Whenever I recommend a screening colonoscopy, there are always patients who ask me about CT colonoscopy (i.e. virtual colonoscopy). The bottom-line is that while it holds promise, it cannot be recommended for general, clinical use yet. It is not as sensitive as a conventional colonoscopy, especially for smaller lesions. And if any lesions are seen, a conventional colonoscopy is needed regardless. One point that seems to ...

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It seems that the major drug companies are flexing their muscle at the GOP convention:

They include an afternoon tea with New York state first lady Libby Pataki, sponsored by AstraZeneca Pharmaceuticals; a nomination-night party for top members of President Bush's re-election team, co-sponsored by Bristol-Myers Squibb; and a breast-cancer awareness luncheon funded by Novartis Pharmaceuticals.

Pfizer is one of the most active drug makers. Its events include a ...

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Summed up in one line

Via Blogborygmi, our surgeon friend from A Cut to Cure . . . gives us a quote that summarizes many of the challenges and frustrations facing physicians today:

An older physician brought this up the other day during a discussion about liability premiums and declining reimbursement. It is a good, simple expression about the frustration many physicians feel:

"Why am I worth so little when I do ...

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Full-body scams indeed

As was commented on by RangelMD and Medpundit, I only have to re-iterate it here. A study was released detailing the harms of full-body scans:

. . . a 45-year-old who has annual full-body scans for 30 years would accumulate an estimated lifetime cancer mortality risk of 1.9 percent, or almost one in 50.

"The radiation dose from a full-body CT scan is comparable to the ...

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In a blatant attempt to capitalize on the MIRACL study sponsored by Pfizer, it seems that Merck's attempts have blown up in their faces. As a reminder, the MIRACL study reported a 16% lower rate of death and nonfatal major cardiac events 4 months after acute coronary syndrome (ACS) in patients receiving 80 mg/d of atorvastatin compared with placebo. This is contrast to the current Zocor study, ...

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. . . take vitamin supplements every day, and I receive continual questions during my office visits about whether they work or not. This nice article summarizes the bottom line: save for a few, most vitamins do not have the appropriate evidence to back their general use.

In a study that will be published in The Lancet shortly, comes the most definitive look at risk factors causing heart disease. Some key observations:

* 90% of the risk factors can be prevented
* risk factors are similar across different regions and race

So, what are the risk factors? Here they are, in order of importance:

1) poor HDL/LDL ratio
2) smoking
3) diabetes

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There is an interesting discussion going on at Blogborygmi. Nick applied the evidence-based Ottawa ankle rules in a situation, only to be overruled by his attending - "in our country, I can't afford not to get an X-ray." Discussion ensued in the comments, with arguments discussing whether EBM is merely a cost-containment strategy versus good medicine.

I would agree with the attending in this ...

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Old dog, new tricks?

So I was having a discussion with a friendly drug rep about McNeil's drug, Flexeril. Now, this is not a new medication, but the 5mg formulation is. The big selling point is similar amount of muscle relaxation with less sedation. What's left out is that the regular 10mg of Flexeril is a generic medication, but 5mg is brand-name only, meaning it's third tier on most health plans. ...

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. . . frivolous lawsuits are an American-only phenomenon, fear not - it happens in Korea as well.

Singapore is offering "medical tourism", slashing rates of medical procedures to lure overseas patients. I guess that's one way to increase revenue.

Back to basics

As we continue to get blitzed with happy-meal style medications like Azithromycin Z-paks and Tri-paks, Biaxin XL-paks, and Levaquin Leva-paks, consider the most recent review from NEJM on bacterial sinusitis. Some excerpts:

In an analysis of a large pharmaceutical database, 29,102 patients were identified with a billing diagnosis of acute sinusitis and a related prescription for an antimicrobial agent. Clinical success was defined as the absence of an ...

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I'm sure that they're in damage control mode after reading about how Vioxx increases heart attack risk.

Patients taking Merck & Co. Inc.'s Vioxx arthritis drug had a 50 percent greater chance of heart attacks and sudden cardiac death than individuals using Pfizer Inc.'s rival Celebrex medicine, according to a large study financed by the U.S. Food and Drug Administration. . .

The study also found patients taking the ...

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Trent has written a dissenting opinion on the piece by Mr. Baker yesterday in the Boston Globe. He writes:

Consumers only want and seek the information if the benefits of such information exceed the costs of finding it. Part of the reason things stand as they do is that patients do not save from finding this pricing information. This is the fundamental problem with third-party payers, whether ...

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. . . gives Charlie Baker's opinion on disclosing health care costs to the public. He is the CEO of Harvard Pilgrim Health Care, an HMO in Massachusetts. I completely agree with his comments.

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